A Pilot Study of Chemoradiotherapy With Weekly Docetaxel for Thoracic Esophageal Carcinoma With T4 and/or M1 Lymph Node Metastasis

Background Patients with unresectable or inoperable esophageal carcinoma are usually treated with definitive chemoradiotherapy. The present standard regimen is radiation with concurrent chemotherapy with cisplatin and fluorouracil. However, significant toxicities have been observed. The efficacy and safety of concurrent chemoradiotherapy with weekly docetaxel for head-and-neck squamous cell carcinoma and non-small cell lung cancer have already been recognized. We conducted a pilot study of definitive chemoradiotherapy with weekly docetaxel for advanced esophageal carcinoma. Methods Nine patients with advanced thoracic esophageal squamous cell carcinoma having a T4 tumor and/or distant lymph node metastasis (M1 LYM) were enrolled. Docetaxel was administered concurrently with 60 Gy of radiation by drip infusion at a dose of 10 mg/m2 for an hour once per week and 6 times in total. Results All 9 patients completed the treatment schedule without any suspension. Grade 3 or higher hematological and biochemical toxicities did not occur. Two patients achieved complete response, and 4 achieved partial response. The response rate was 67%. The median survival time was 16.2 months and the 2-year survival rate was 38.9%. Conclusions Concurrent chemoradiotherapy with weekly low dose docetaxel is a safe and effective treatment regimen for esophageal squamous cell carcinoma. We expect that this protocol of chemoradiotherapy may be one of the choices of treatment substituting the regimen with cisplatin and fluorouracil, particularly for the patients for whom chemotherapy with cisplatin and fluorouracil is considered inappropriate because of concomitant renal dysfunction or prior failure of systemic chemotherapy with cisplatin and fluorouracil.